li limilli@l *1 -M-EMORANDUM DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION BUREAU OF HEALTH RESOURCES DEVELOPMENT TO Acting Director, Division of DATE:December 5, 1974 Regional Medical Programs FROM Public Ho Advisor SUBJECT: Background material for discussion on Arthritis Conference on Dec. 5 With reference to our telephone conversation this morning, the enclose material is the basis of the general discussion I would like to have with you at 3:00 p.m. today. The discussion need.,not be long, as my agenda is to go over with you (a) where matters stand, (b) explore any potential problem areas vis a vis DRMP, and (c) obtain clearance on potential, small cost items. Since I do not (blearly recall which documents have been forwarded to you for information, I am &nclosing the following: 1. A letter to Dr. Shulman, President of the Americal Rheumatism Association, the professional organization of the Arthritis Foundation. The letter updates him on events, and transmits the report on the Chicago Discussion. 2. A memorandum to 5 of the "consultants" who were, on November 25, in Washington to testify on the Cranston Bill. I was able to deliver this material to them at the Rayburn Building. There has been no play=back, to date. This document is the first 'hard" proposal on the Conference, proper; it is the result of the experience I had at the San Francisco meeting of the western Coordinators on arthritis, and discussions which Dr. Englemen@ and I had on the plane, returning to Washington. 3. The third document is an itemization of activities and functions surrounding the conference proper. It will become a part of a larger document I am preparing to send to the involved people for (a) their information, and (b) concurrence on what is being done. I may be able at the same time to include some concepts on conference subject matter which, I hope, will elicit ecten- Sion of ideas from them. Items Nos. 2, and 3, are most pertinent to our discussion. Enclosures e c ., /@ 'r) 17@ DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUE]LIC HEALTH SERVICE HEALTH RESOURCES ADMINISTRATION ROCKVILLE. MARYLAND 20852 BUREAU OF HEALTH RESOURCES DEVELOPMENT November 22, 1974 Lawrence E. Shulman, M.D., Ph.D. 916 Clinical Science Building Johns Hopkins Hospi.ta' Baltimore, Marvland 21205 Dear Dr. Shulman: This follows up our telephone conversation of about two weeks ago to keep you advised regarding progress and arrangements for pilot arthritis Pro- gran followup. I have enclosed a statement I developed for our guidance in the Division of Regional Medical Programs.regarding the Chicago O'Hare "fly-in" discussion on November 17. It is enclosed not only to save rewriting, but to permit others receiving copies of this letter to advise me of any misrepresentations. I wish, first, to co'nvey our feelings of sincere appreciation of the interest.and thoughtfulness extended by each of the participants in the Chica-o discussion. This was not a 11 Pat" meeting; most of the points I have enumerated in the enclosure elicited initial differences of opinions, and were subjected to considerable scrutiny by the group. I believe however, that doubts have been moderated if not retired, and that there is positive consensus regarding the need for the arthritis conference, C) and the potential it provides for substantive results. Several key factors affected the outcome of the Chicago discussion which are not apparent in my. summary. First, enroute to the meeting, I was advised by Mr. Garoell, Acting Division Chief, that funds I had believed to be available as our contribution toward the conference were not, in fact, available. We will continue to seek identification of a Federal contribution, but the prospect is not bright. Secondly, it was agreed that the conference should constitute a working session on t e present funded pilot programs, their present circumstances, and future; atten- dance should be limited accordingly. It was agreed that the members of. the Arthritis Ad Hoc Review Committee should be invited. I estimate that the conference will require the attendance of about 120 people. This includes 29 PI-!P representatives, about 60 Project Directors, and the remainder made up by representatives of the sponsor- ing agencies, resource specialists, and guests. 2 For your information, Dr. Evelyn Iless is contacting all Of the pilot arthritis Project Directors to explore the possibility of developing data within the ARA uniform reporting format. Also, the Michigan @-T is contracting with the University of Michigan School of Public licalth to carry out evaluation of Dr. Ivan Duff's geriatric demonstration. This might provide an avenue of interest other schools of public health to perform similar evaluative work. I was provided an opportunity yesterday to discuss conference plans with the Steering Committee of the National Association of @T Coordinators. On Saturday, Noveiitber 23, there will be an opportunity to discuss the program and coference plans at a one-day arthritis conference in San Francisco of the Western Regional Iledicztl Programs (7 or 8 states). I will need and sincerely appreciate your counsel about the conference as it develops. We will be able to announce the date and location next week. I am obtaining cost and support information on both Kansas City and St. Louis, which are, in the aggregate, the least-cost sites of 11 which we priced out in some detail. I prefer Kansas City because of the existande of a strong Kansas Pd,!P and arthritis program,and an active local Arthritis Chapter. We are inviting these respective K.C offices to serve as hosts to the conference if it is, in fact, schedull.ed there. I trust that these comments will assure you that plans for an effective conference are moving forward. I look forward to your counsel with reSpeCL Lu pLoyi:zLLIL Z5UU@L.CtLiLt::, CLLL%A rCy op@"M-@o. Sincerely, -"a Public Health Advisor Division of Regional Medical Programs Enclosure Tele: 301/443-1916 Address: Division of Regional Medical Programs Parklawn Building,, Room 15-42 5600 Fishers Lane Rockville, Maryland 20852 cc: Dr. Roger D. Mason Dr. Lawrence 11. Petrocilli Mr. Kevin Anderson Mr. David Shobe Dr. William F. Donaldson Dr. Clement W. Sledge Dr. Ephraim P. Engleman Dr. Isaac Taylor Dr. Satoru Izutsu Dr. Charles D. Tourtelotte Mr. Gerald Gardell ORGAINIZATION FOR A NATIONAL ARTIIRITIS CONFERENCE ,A discussion was held at O'llare International airport, Chicago, Illinois, on Sunday, Tiovcrbcr 17, to c-.-plore the feasibility of convening a conference to develop coordinated activities, including program reporting and evaluation, among 29 Regional '.Icdicil Prograr-s (T','2"s) coiiductin- pilot arthritis grant programs. Participants in tile discussion were: Dr. Roger D. Mason, discussion moderator; Chairman of the former Arthritis ad hoc Review Co,-@-iittee Mr. Kevin Anderson, staff mer,.'Der, @!ichigan kT Dr. William F. Donaldson, lst Vice President, American Academy of Ortho- paedic Surgeons (Pittsburgh) Dr. Ephraim P. Engleman, UCLA; chairman of the ARA "committee of five" designated to provide iiaison with Dr@-al (San Francisco) Dr. Satoru lzutsu, txecutive Director, ilawLiii K-12 1 i rhi Pf Art-,'hri tiq Activities. INIIA.@IDD Mr. David Shobe, Arthr4-tis Foundation (Washington, D.C., and N.Y.) Dr. Clement W. Sledge, Robert Brec'N- Brighan@ I!ospital (Boston) Dr. Isaac Taylor, Deputv Director, Tri-State KT Dr. Charles D. Tourtelbtte, Chief of Rheumatology, Temple University (Philadelphia) From the Division of Regional Medical Programs: Mr. Gerald T. Gardell,.,Ac-ting Director Mr. Matthew Spear, Stafi member The consensijsses reached'by the discussion participants are the following: 1. There should be a conference to develop coordination, evaluation-, and follow- up activities among the 29 funded pilot arthritis programs. 2. The conference should be convened at a site which results in least cost for .both the conduct of the conference, and the attendance of the participants. 3. Total cost of the conference proper (site and services costs shou not exceed $10,000. 4. Conference sponsors will be, jointly: Arthritis Fo undation American Academy of Ortliopaedic Surgeons National Institute of Arthritis, I-letabolis-,n, and Digestive Disease Regional ',Iledical Programs (29 collectively) 5. The sponsors will jointly contrive to pay the costs of the conference. 6. Participating program attendees will be requixcd to meet their travel and other costs from local sourc6s. 7o Prcgram attend.--icc/parti'cipation-will be limited to Coordinators of the 29 P@,P's with funded pilot arthritis prograz:s, their arthritis Project Directors, and others.d@rectly associated with the conduct of the conference. 8. Soccial guests, and e-.@pert resource personnel will be invited. Their costs of participation will be reimbursed by the sponsors, when necessary. 9. The conference will be'schedulled for 2 days in the period between January 18, and February 2, 1975. 10. D@IP will provide staff support -- in effect, an Executive Secretariat for development, cond,uct, and perhaps followup of the conference. 11. The tentative program structure is: I. Educational impact A. Physicians B. Paramedical C. Patients II. Delivery Impact A. Demographic aspects B. Types of services C. Distribution of services III. Objective analysis of results A. Each of the above B. Functfonal analysis of therapy IV. Continuation funding 12. The structure relates to the following tentative agenda: a. short introductory plenary session b. workshops on sections I, and II c. plenary session for reports and discussions d. workshops on sections III, and IV e. surmary plenary session available in both the worksh p, nd S-,)ccial resource people should be , 0 a plenary sessions. Types (or specialties noted): deirogripliy progra-i evaluation program funding program inforriatJ.on disse.-Pinitors program image builders Names mentioned: demograpliy William Ranke (?), Johns Ilop@ins, Ild. evaluation Dennison, Iticli.; Plotz, N.Y.; Dr. Smyth, Colo.; Confree, Cal.; Joseph Barbacci,@, Cal. funding --- David RoFers,'Johnsoii Foundation Kellog- Foundation t, State Ilealtli Department specialists program delivery -- Ed. Smltli, Va.; John Sharp, Houston, and Smiley, Dallas, Texas; Nci-ist@idt, 'Louiseville; Ivan Duff, I-lich.,; Dr. Klineberg, .and George Freo (?), Cal. program information -- one or two widely lnow n science writers urogram imav!e Sen. Cranston: Anne Lniidcrs AIEAIORANDUM DEI'Alt'l',%Il-"N'I' Ol-' lif@AI,I'll, 1--I)UCAI'ION, ANI) %%'I-.LFAIti )II-'Al.l'll RESOUItClIS Al).%IINISI'RATION SURI-'AU OF l(ESOUItCl',S TO :Dr. Donaldson DATE: November 25, 1974 Dr. Engleman Mr. Shobe Dr. Shulman FRO.%F SUDJE(-'r'Proposed organization of an arthritis conference The enclosed pages set forth (albeit hurriedly) a proposed format and organization for the arthritis conference discussed at Chicago on Nov. 17. The format seeks to provide maximum participation to develop a forward looking perspective, and a degree of collective action by program participants. The characteristics seem critical to me in view of the prospects. If we dry up and go away for lack of Federal support, the.present investment must be optimally employed, adequately documented, and permitted to provide a bridge to whatever local continuity as can be elicited. If additional, similar support evolves, the present program must be in position to move forward appropriately. This is the basis on which I have striven to define a method @ through which the combined elements of the existing pilot arthritis program ea ocussed on a forward looking, active venture. The conference must not, in my thinking) be allowed to lapse into a passive talkfest. Similarly, it must occur in a time and manner in which there is maximum involvement and interest, and serve to maintain or build on those characteristics. The proposed attendance results in the presence of a wide spectrum of experience and outlook. The proposed techniques are an attempt to capture both the conscious, and subconscious expressions of this reservoir, and to highlight program perspectives which are, respectively, shared and unique. It'may be too much to anticipate and plan for collaborative'actions as an outcome from this single conference However, we can assure "undershooting" if we don't aim, and press for hard targets. The proposal needs critical examination. If we progress in this, or a-- similar format, planning ana logistics must be carefully developed. Enclosures Confei-ence on Pilot Arthritis Programs Purposes Outcomes. A. Share program experiences A. Relate and coordinate like activities 1. Program developmental approaches 1. Obtain interprogram 2. Significant problems assistance 3. Problem resolutions 2. Establish a newsletter B. Define overall program goal (s) B. Establish a central program reporting and analysis 1. Identify major obectives activity. 2. Identify principal forces, or program elements C. Identify major criteria of program C. Establish a reporting format outcome for delivery and schedule 1. Professional training 2. Patient training 3. Program services n TA^-@4-C., 4-U techniques (to emply criteria) and counseling activity 1. - 2. 3. - (as C above) E. Identify feasible program continuation E. Report (via newsletter) (activities/support) activities which win continuity. support. 3. (as Cabove) Schematic plan for an arthritis conference January 1975 Basis of Plan Representatives of 29 pilot arthritis programs will be convened; with others, to: a. Share program experiences. b. Develop a perspective of the program, as an initiation of arthritis control activities. C* Identify salient factors of program strengths, and continuity elements. d. Devise processes for program reporting for coordination, and evaluation. e. Specify collaborative roles, or functions, to be executed to effect program quality improvement, coordination of like activities, and evaluation. Thus, the conference process must be a joint working session which initiates, if it cannot fully realize, leadership roles which draw forth participatory commitments from a wide range of individuals and groups. The objective is the establishment and coalescence of a broad constituency embracing both those required to effect delivery of good program, and those who can elicit active awareness from Conference Program Plan Conference events must be formulated to elicit the experiences and judgements of present program ledders, and amalgamate their perspec- tives and expectations into unified objectives to be achieved within a stated period. To achieve this, conference activities will put the participants to work almost at the outset, and keep them actively engaged in a process of rapid definition of feasible actions which they can agree to undertake individually, and jointly. A series of workshops will be conducted which will: 1. highlight major pr ogram requirements 2. emphasize similarities of perspectives 3. reveal innovative approaches 4. specify actions required to be undertaken with some uniformity. The process is an offshoot of the "brainstorming" conference approach, and will permit: a. direction: The matters to be addressed by the conference will be determined'by the key questions posed to the participants. 2 b. maximum input: everyone will be provided opportunity to express judgements and opinions. co rapidity of response: participant responses will be obtained simultaneously; the workshop function is to focus participant responses into coherent statements of perspectives, objectives, and initiatives. It remains questionable at this time whether the brainstorming process can be effectively conducted as a plenary session activity because of logistic, and. participant fatigue problems. However, this plan assumes that these problems can be managed. A. Requirements 1. A leader with a set of focussed questions. The questions must be orally stated to the participants and also , individually displayed, as they are posed, on a large placard. 2. Participants must have several 3" x 5" pads of note paper, and pen/pencil. 3. Ushers must be available tp pick up the 3" x 5" pages 'HILUR t!acti quet;Lioii sess.LOII. 4. A small collator and typing staff must be available in a separate room. 5. Meeting rooms are needed for designated groups (work- s4s). Workshops address themselves to specific questions, and the responses provide4,by plenary activity; the plenary responses areain the hands of th& members of the designated workshop via the collator/typing team. Sample procesis: 1. Leader states the question, which is simultaneously displayed in large print. 2. Leader states the time limit (2-3@min.) which participants have to write down all the responses which occur to them. 3. Participants write one answer on one 3" x 5" page, proceed- ing to successive pages as responses occur. 4. Leader calls TIME; ushers pick up all answers (collect in plastic bage). Responses are delivered to the collatot/ typing room. 5. Leader proceeds to next question; etc. 3 When all (or a designated set) questions are completed, a series of talks is presented relating to the conference interest. This provides the collator/typing team time to complete their work in preparation for the workshops. The collator/typing team process must not screen response!-,. The limiting factor will be time; all the responses which can be typed within a'time limit must be prepared for perusal, discussion, and resolution by the designated workshop. Everyone must know what is occur ring, but nothing must be done overtly which inhibits full, and free response from all participants. Workshops then Iroceed on the questions, and responses provided in the plenary question session. Unless logistic prospects require modification of this plan, each workshop will deal with specific propositions with respect to which it has input from the aggregate conference. Workshop output is: 1. A synthesis of-the conference perspectives 2. Statement of feasible objectives 3. Recommendations on conference positions, and appropriate followon initiatives. Workshop deliberations will be reported to a plenary session by the Workshop leader. An approximate sequence for th"@"P-proposed activities is attached. T s t ])AY Time Program Related Sequence Activities Activities a.in.9:00---- Welconic/Introductions - Explanation of Agenda -- Instructions on Questions - Questions posed 10:00---- Collation/typing team pick up - responses, arrange, and type -- Coffee Break in form to be handed to workshops - 11:00---- Reassemble, Introduce speakers-1- - (15 min. presentations of -- representative arthritis - programs.) Noonl2:00---- LUNCH - -- Presentation on - operating program p.m.1:00---- evaluation. -- Workshops - 2:00---- (Simultaneous consideration - of Education Impact, and Delivery Impact aspects by a number of workshops. 3:00---- Breakout determined by bpt::CJ-L.Lt;.LLV (ii questions Coffee Break Reassemble in Plenary .4.:OO---- Workshop Reports -- - 5:00---- Plenary Discussions - Positions defined; voting -- proceeds, if appropriate. - 6:00---- Cocktails - 7:00---- Dinner Conference Keynote Speaker#- 8:00---- r iid I AY Time Pro ram Related Sequence Act@vities Activi ties - -- - a.m. 8:00---- Assemble in Plenary - Questions posed --. Collator/typing treani - Presentations of pick up responses, arrange 9:00---- special programs-@- and type to band to - workshops. -- Workshops - 10:00---- 11:00---- - -- Reassemble in Plenary - Workshop reports Noon 12:00---- - -- LUNCII - p.m.1:00---- (Presentations on - funding opportunities) - Typing of previous 2:00 ---- -- -- -- Reassemble in Plenary papers, etc. - -- (Act on morning's workshops - and overall Confere@ce 3:00---- positions/outcomes. If there - is to be suggested designation -- of perso-,is/organizations to take - actions, it should occur here.) 4:00 ---- -- -- -- ADJOURN (Post-donference wrap-up taken up -- e.g., transcript ---- wording, individual followup assignments, etc.) Typing as required Si@e.., Aje-A@ej F"-ma-F, Fstim' aTed do3-t5, @d we-) Ste A )e@ a.3 14 13 d6 a .1 xdtjlrng) mti4oc-a PYDI yam (Xtorelejda -st4yo@ A Y@y s .4 Tyeve.)IPP-Y..Diev" or- eim@ CY py, oi e ct r_@, -x@t*$ e-*e f- Si@Te/.15eyvi;,e &s@-S c@ &.X I'%% WW$) @g?, Av"eyi-caA Aca of. e@-s 4, AyllyiT,.'s Fi4 i C.. [L) A@@yev@ati'ms'. AAD-5 A@. Aral. oF Oy-fto. Suy3e@ A F: 'DRhiP Pi'v. of FeS I MeJ. P-rojraw-i nm H lote, I MIA c b)e- b a C, k KeA F I